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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001904
Report Date: 04/10/2024
Date Signed: 04/10/2024 12:46:47 PM


Document Has Been Signed on 04/10/2024 12:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:L.P. NUNEZ CARE FACILITYFACILITY NUMBER:
347001904
ADMINISTRATOR:BRIAN A. JOHNSONFACILITY TYPE:
740
ADDRESS:8000 35TH AVENUETELEPHONE:
(916) 386-8332
CITY:SACRAMENTOSTATE: CAZIP CODE:
95824
CAPACITY:4CENSUS: 4DATE:
04/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:FERDINAND SADAYA - DIRECT CARE STAFFTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced 1 Year Required Annual Inspection Visit. LPA met with the direct care staff and explained purpose of the visit. Administrator Certificate expires 3/26/2026.

LPA and direct care staff toured the facility and inspected physical plant including but not limited to kitchen, bedrooms, bathrooms, living and dining room area. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in the facility. LPA measured the hot water temperature in resident's bathroom at 109.6 degrees Fahrenheit which is within the required range of 105 to 120 degrees. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire Extinguisher last inspected 3/20/2024 and smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present and in working order. The facility conducts fire/disaster drills with residents on 3/4/2024.
LPA observed centrally stored medications, knives and toxins locked and not accessible to residents.

LPA reviewed four resident files and three staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are Fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. First aid/CPR certificates are current. First aid kit was checked and is complete.

LPA received the updated documents for community care licensing on today's date: LIC 610-D Emergency Disaster Plan, Liability Insurance, and Copy of Surety Bond with expiration date.
Based on today’s visit, Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies observed or cited today.
Exit interview conducted with administrator. A copy of report and LIC 811 (Confidential Names) left at facility.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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